Ghuge P P, Kute V B, Vanikar A V, Gumber M R, Gera D N, Patel H V, Shah P R, Modi P R, Shah V R, Trivedi H L
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
Indian J Nephrol. 2013 Nov;23(6):448-51. doi: 10.4103/0971-4065.120344.
Deceased donors (DDs) with the brain death due to head injury are the major source of organs for transplantation. The incidence of post-head injury disseminated intravascular coagulation (DIC) ranges from 24% to 50%. Many centers do not accept organs from donors with DIC due to increased risk of primary graft non-function and/or high chances of morbidity/mortality. We performed two successful renal transplants from a DD with head injury with DIC and deranged renal function. One of the recipients developed transient thrombocytopenia, but there was no evidence of DIC or delayed graft functions in either of the recipients. Over a follow-up of 1 month, both are doing well with stable graft function and hematological profile. Thus, a carefully selected DD with severe DIC even with deranged renal function is not a contraindication for organ donation if other risk factors for primary non-function are excluded. This approach will also help in overcoming organ shortage.
因头部受伤导致脑死亡的已故捐赠者(DDs)是器官移植的主要来源。头部受伤后弥散性血管内凝血(DIC)的发生率在24%至50%之间。由于原发性移植物无功能的风险增加和/或发病/死亡几率较高,许多中心不接受患有DIC的捐赠者的器官。我们成功地进行了两例肾移植,供体为一名患有头部受伤合并DIC且肾功能紊乱的DD。其中一名受者出现了短暂性血小板减少症,但两名受者均无DIC或移植肾功能延迟的证据。在1个月的随访中,两人情况良好,移植肾功能和血液学指标稳定。因此,如果排除了原发性无功能的其他风险因素,即使肾功能紊乱,经过精心挑选的患有严重DIC的DD也不是器官捐赠的禁忌证。这种方法也将有助于克服器官短缺问题。